- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $3,981.07
| Facility | | $1,348.96 | $1,348.96 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,778.28 / $1,778.28 / $1,778.28
| Facility | 50 | $1,778.28 | $1,778.28 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $93.33 / $316.23
| Professional | | $50.12 | $93.33 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $32.36 / $288.40 / $380.19
| Professional | 50 | $32.36 | $288.40 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $389.05 / $645.65
| Facility | | $190.55 | $389.05 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $83.18 / $147.91
| Professional | | $47.86 | $83.18 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $107.15 / $177.83
| Professional | | $63.10 | $107.15 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,412.54 / $6,456.54
| Facility | | $436.52 | $1,412.54 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $91.20 / $165.96
| Professional | | $51.29 | $91.20 | $165.96 |